Serosorting, ‘strategic positioning’ commonly practiced by
MSM with HIV to reduce transmission risk
More than 40% of HIV-positive men who have sex with men in the United
States reported having unprotected anal intercourse, according to findings of a
new meta-analysis published in AIDS.
The results also indicated that MSM engaging in unprotected sex often
attempted to limit the risk of HIV transmission to partners by employing
strategies such as serosorting or “strategic positioning,” defined as
adopting the receptive role during unprotected sex.
Various studies conducted in the past have examined the prevalence of
unprotected anal intercourse among MSM with HIV. To obtain a synthesis of the
findings of this research, researchers performed a meta-analysis of the results
of 30 studies conducted between 2000 and 2007 that examined unprotected sexual
behaviors in this patient population. A total of 18,121 MSM were represented in
the meta-analysis. The median age of the study participants was 38 years. The
median duration of diagnosed HIV infection was 70 months; the proportion of
patients taking antiretroviral therapy ranged from 23% to 89%.
“We found that a sizeable percentage of HIV-diagnosed men who have
sex with men engaged in unprotected anal intercourse with male partners,”
the researchers wrote. “This is an important public health concern, given
the high prevalence of HIV and STDs among MSM in the United States.”
However, the results also indicated that some MSM with HIV engage in
behaviors that may lessen the probability of infecting others. Although 43% of
MSM with HIV reported engaging in unprotected anal sex, only 26% reported
unprotected sex with a man who was HIV-negative or of unknown HIV status.
Furthermore, there was evidence that men were attempting to reduce the risk of
HIV transmission to HIV-negative partners by adopting a receptive role during
unprotected sex (9% receptive vs. 5% insertive).
The researchers said these findings may be “useful for targeted
prevention efforts” and suggested that a priority for such work should be
“the safety of serosorting and strategic positioning.”
Crepaz N et al. AIDS. 2009;23:1617-1629.
Canadian public health officials warn of escalating HIV/AIDS crisis
among Aboriginal communities
The HIV/AIDS epidemic among aboriginal communities in Saskatchewan is
similar to that found in some African countries, according to Canadian public
health officials. Data indicate that 174 new cases of HIV were recorded in
Saskatchewan last year. This is a threefold increase since 2004; aboriginals
were the “hardest-hit group,” according to the Canadian Ministry of
Health.
“HIV in this province will kill 15 to 30% [of the aboriginal
population] – not all at one time, but over a five- to 10-year
period,” Khami Chokani, MD, medical health officer for the Prince
Albert Parkland Health Region, said in a press release.
Moira McKinnon, MD, Saskatchewan’s chief medical officer,
said the effects of the epidemic are being seen throughout the province.
“In the public health sector, this is having a considerable effect, as
these increases are appearing primarily in the young females, pregnant women,
and newborn babies,” she said in a press release. “There are babies
being born with HIV and that’s completely avoidable. We know that young
girls are getting infected and they are getting sick very quickly, and all of
this is avoidable, if we get onto it.”
McKinnon said she believes one problem driving the epidemic is that the
flow of information between health authorities and the Aborigine communities is
often poor, and the province needs more resources to deal with its increasing
caseload.
Improvements in fighting HIV/AIDS seen in Washington, D.C.
Public health officials in Washington, D.C., made improvements in
fighting HIV/AIDS in the past year by increasing HIV tests, funding needle
exchange programs and producing detailed data on the number of patients with
HIV in the District, according to a new report by the D.C. Appleseed Center for
Law and Justice.
The report also found that despite these improvements in public health
policy, Washington, D.C. still has the worst HIV/AIDS rate in the nation.
The report was the fifth “Report Card” on the city’s
response to HIV/AIDS by the D.C. Appleseed Center for Law and Justice.
Authors of the report praised District public health officials for
making Washington, D.C. one of three cities that administer the most HIV/AIDS
tests, for coordinating government agencies responding to the epidemic and for
strengthening the team in the HIV/AIDS Administration, which gathers data on
the illness. The government also received above- average grades for leadership,
managing grants to groups that help people with the illness, and monitoring the
effectiveness of those programs.
But the report criticized Mayor Adrian M. Fenty for failing to give the
disease “more visibility.” The report said that Fenty’s
“public appearances and statements about the epidemic have fallen short of
his enthusiasm for action inside the government.”
Patients with HIV will receive priority for influenza A (H1N1)
vaccination in UK
Patients with HIV will be one of the priority groups for influenza A
(H1N1) vaccination in the United Kingdom, according to plans released recently
by the U.K. Department of Health.
The U.K. Secretary of State for Health’s office announced that
people with underlying health conditions, including HIV, would be first in line
for the vaccination. The vaccine is expected to be available this fall.
Health officials have said that there is no indication that patients
with HIV are at a greater risk for influenza A (H1N1) or for developing
complications should they contract it, unless they have a low CD4 cell count.
New HIV prevention campaign launched in Uganda
A new anti-HIV/AIDS campaign has recently been launched in Uganda by the
AIDS Healthcare Foundation. The campaign, called “Stay Negative and Love
Condoms,” is designed to encourage safe sex practices.
The five-month campaign will include free condom distribution throughout
Uganda and free HIV testing, according to Benard Okongo, managing director of
the AIDS Healthcare Foundation.
This campaign is expected to mirror similar campaigns previously
launched by the AIDS Healthcare Foundation in Swaziland, India and South
Africa.
Three cases of HIV in children linked to prechewed food
The practice of feeding children premasticated
(prechewed) food may be a potential source of late HIV transmission previously
attributed to breast-feeding, according to U.S. health officials.
Investigators from St. Jude Children’s Research
Hospital, the University of Miami, the CDC and several other sites performed
epidemiological investigations after receiving notification of HIV diagnoses in
three previously healthy children aged 9, 15 and 29 months who had a parent or
caregiver infected with the virus. In all three cases, the children were fed
premasticated food on multiple occasions by a caregiver with HIV. No known
alternative route of HIV transmission could be identified in these cases.
The researchers said a combination of circumstances,
including oral bleeding among the caregivers, lack of access or adherence to
antiretroviral therapy and compromised oral mucosa in children who were fed the
prechewed food, may explain this previously unreported route of transmission.
Oral bleeding in the mouth of the adult at the time of
prechewing was reported in two of the three cases. During interviews with
health care providers, the mother of the 9-month-old reported that she had fed
the child prechewed meats from the age of about 120 days on and that she had
experienced intermittent mouth sores and bleeding gums during that time period.
In the case of the 15-month-old, the child is believed
to have contracted HIV from a maternal great aunt whose HIV status was unknown
at the time. The mother witnessed the great aunt feed the child prechewed food
and had noticed blood mixed in with the food from the aunt’s gums.
However, researchers were unable to confirm a phylogenetic relationship between
the child’s HIV strain and that of the great aunt, as no blood specimens
collected before her death were available.
The mother of the 29-month-old could not remember
details about her oral health during the time that she fed the baby prechewed
food.
“Premastication-related HIV transmissions are
probably rare, requiring a convergence of risk factors affecting both the
caregiver and the child,” the researchers wrote. They noted that HIV
transmission has not previously been linked to this practice, as relatively
little is known about its prevalence in the West.
In efforts to learn more about the prevalence of
premasticated feeding practices, the CDC and FDA incorporated questions about
prechewed food into the Infant Feeding Practices Study II, a questionnaire
mailed to a sample of U.S. women who had recently given birth. The findings
were unexpected, according to the researchers.
Unpublished results from this feeding survey indicate that 10.5% of
1,794 respondents (n=189) had fed prechewed food to their children by the age
of 10 months, and that the prevalence of this behavior was higher among a
subset of black respondents compared with other racial and ethnic groups. In
this subset, by the age of 4 months, 6% of 87 respondents had premasticated
food for their children with this rate increasing to 50% of 88 respondents by
the time their child was aged 10 months.
Gaur AH et al. Pediatrics. 2009;124:658-666.